Heart Rate Variations: When to Worry and Medication Effects

Medication consultation

Thank you, Doctor, for providing me with so much medical knowledge.
I would like to ask you again: is a simple increase in heart rate not a disease and poses no life-threatening risk? I might have been really scared during my emergency visit when my heart rate reached 180, but it was not PSVT.
Does this mean that if my heart rate goes up again in the future, I don’t need to panic or rush to the emergency room?
Additionally, I would like to ask about my current medication regimen.
I take my antiarrhythmic medication around 10-11 AM, which is when I usually wake up.
However, I feel that the medication's effects last until the evening.
After taking the medication, my heart rate while resting, sitting, or lying down is around 70-80 bpm.
However, when I get up and walk around, it sometimes increases to 105-120 bpm, but it drops back down to 90-80-70 bpm when I sit down.
Is this normal?
When I am sitting or lying down, my heart rate is quite normal and beautiful at 60-70 bpm, but when I stand up without walking, it goes up to 90-100 bpm.
Does this count as postural tachycardia? There is also another situation: after taking the antiarrhythmic medication, when I wake up the next morning and haven’t taken it yet, my heart rate can be 120-130 bpm while brushing my teeth and washing my face.
Is this normal, or is it just psychological stress? Does the medication lose its effectiveness by that afternoon or evening? How long does it typically take for the antiarrhythmic medication to be completely metabolized and lose its effect?
I apologize for having so many questions, Doctor.
You have been a great help to me, and I truly appreciate it! Although I am still anxious, I am slowly improving, thanks to you! Thank you so much, and I wish you well.

Niming, 20~29 year old female. Ask Date: 2023/06/20

Dr. He Dongjin reply Cardiology

Hello, that's correct.
A simple fast heartbeat is not a disease and does not pose a life-threatening risk.
There's no need to be afraid or rush to the emergency room.
Rest and take it easy; it's normal for your heart rate to increase to 120-130 beats per minute when you're feeling anxious.
The effectiveness of heart rhythm medications varies from person to person, as everyone's metabolic rate is different.
Just relax; everything is fine.
Changhua Hospital cares about you.

Reply Date: 2023/06/20

More Info

Thank you for your detailed questions and for sharing your medical history. It's clear that you're experiencing a range of heart rate variations and are understandably concerned about their implications. Let's break down your concerns regarding heart rate, medication effects, and when to seek medical attention.

Understanding Heart Rate Variations
Firstly, it's important to understand that heart rate can vary significantly based on a variety of factors, including physical activity, emotional state, and even body position. A resting heart rate typically ranges from 60 to 100 beats per minute (bpm) for adults. When you stand up or engage in physical activity, it's normal for your heart rate to increase to supply more oxygen to your muscles.
From your description, it seems that your heart rate increases to 105-120 bpm when you stand up or walk, which can be considered a normal physiological response, especially if you are otherwise feeling well. This phenomenon is often referred to as "orthostatic tachycardia," which is a common response to changes in posture.

Medication Effects
Regarding your medication, it sounds like you are taking a beta-blocker (心律錠), which is designed to help manage heart rate and blood pressure. Beta-blockers work by blocking the effects of adrenaline on the heart, leading to a slower heart rate and reduced blood pressure. The effects of beta-blockers can last several hours, but their duration can vary based on the specific medication and individual metabolism. Generally, the half-life of beta-blockers is around 3 to 5 hours, meaning that their effects can diminish significantly by the next morning, especially if taken once daily.

If you notice that your heart rate is still elevated (120-130 bpm) shortly after waking up, it could be due to several factors, including residual effects of the medication, anxiety, or even dehydration. It's not uncommon for individuals to experience a higher heart rate upon waking, especially if they are anxious or have just gotten out of bed.

When to Worry
You mentioned a previous experience where your heart rate reached 180 bpm, which understandably caused concern. While a rapid heart rate can be alarming, it's crucial to assess the context. If you experience a rapid heart rate without accompanying symptoms such as chest pain, shortness of breath, or dizziness, it may not be an immediate cause for alarm. However, if you do experience these symptoms, or if the rapid heart rate persists, it is advisable to seek medical attention.

Anxiety and Heart Rate
It's also worth noting that anxiety can significantly impact heart rate. If you find yourself feeling anxious about your heart rate, this can create a feedback loop where anxiety increases your heart rate, which in turn increases your anxiety. Techniques such as deep breathing, mindfulness, and relaxation exercises can be beneficial in managing anxiety and its effects on your heart rate.

Conclusion
In summary, while variations in heart rate can be concerning, they are often normal physiological responses, especially in the context of posture changes and medication effects. Your current heart rate responses appear to be within a reasonable range, particularly if you are not experiencing any distressing symptoms. However, if you have ongoing concerns or if your symptoms change, it is always best to consult with your healthcare provider for personalized advice and potential adjustments to your treatment plan.

It's great to hear that you are feeling some improvement in your anxiety, and I encourage you to continue working with your healthcare team to monitor your heart health. Thank you for trusting me with your questions, and I wish you continued progress and peace of mind.

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